Anomalies of the Feet:
Prevention and Cure of Bunions and Hammertoes

By Ray McClanahan, D.P.M.

Bunions are a sometimes painful dislocation of the first metatarsophalangeal joint or fifth metatarsophalageal joint that occurs primarily in shoe-wearing populations.

There have been many suggested causes of bunions, but the one cause shown to be consistently reversible is the tapering toeboxes on most conventional footwear. Tapering toeboxes have a long history of standard inclusion in most shoe models, including most athletic models. The unfortunate side effect of the tapered forefoot shape of our footwear is that it holds our toe bones and joints in an unnatural proximity to one another, forcing the great toe into the space that should be occupied by the second toe, creating the classical bunion deformity. The tailors bunion, on the outside of the foot, is created when the fifth toe is forced in under the fourth toe, and the head of the fifth metatarsal is forced into the outer aspect of the shoe, sometimes causing pain, swelling, or bursa formation.

Unfortunately, the taper of the toeboxes on most footwear available in America begins at the metatarsophalangeal joints instead of at the ends of the toes where the natural forefoot shape is at its widest. The only opportunity to see the natural shape of a human forefoot in America is in the newborn infant or in the rare individual that grew up barefoot. Growing up without shoes keeps the shoe from unnaturally pushing our toes together. In societies where children grow up barefoot, deformities such as bunions and hammertoe are rarely seen.

Hammertoes are another forefoot deformity that can take a walker out of activity. Hammertoes generally represent a tendon imbalance in the toes caused by one of the toe tendons getting an advantage over another toe tendon. Most commonly, it is one or all of the long extensor tendons on top of the foot that gets an advantage over one or all of the flexor tendons on the bottom of the foot. This causes the first joint in the toe to be elevated above the ground. Whether they know it or not, most shoe-wearing people chronically alter the delicate balance that co-exists among the toe tendons.

This occurs because most footwear has an elevated heel and a feature called toespring, which holds the ends of the toes above the ground in relation to the ball of the foot. These features, coupled with the tapering toeboxes, are responsible for the development of most hammertoe deformities.

Although the following preventive tips may be able to reverse a painful bunion or hammertoe deformity, they are more effective when applied to young people and are less effective the longer a person has progressed with their bunion or hammertoe deformity. The sooner the treatment, the better the result.

If you wish to prevent or cure a bunion or hammertoe deformity naturally, you must be willing to view your footwear as health equipment rather than as fashion statements. Since fashion and style rule most people’s agenda when it comes to buying footwear, even our walking and running shoes have tapering toeboxes, heel elevation, and toespring, which encourage bunion and hammertoe formation.

Therefore, it takes persistence to find a shoe that is widest at the ends of the toes. A good method of guaranteeing you will have enough room is to remove the sock liners that come with the shoes and stand on them. Make sure there is enough room for all of your toes to lay flat on top of the liner without going over the edges. Your persistence will pay off, since optimum walking occurs when the toes are fully spread.

If you have a more advanced bunion or hammertoe deformity and have success finding a wide enough shoe to allow you to spread your great toe away from your second toe, you may have success conservatively reversing your condition with the use of a toe spreader or bunion splint. Though many try, using a bunion splint in a conventional shoe with a tapered toebox is certain to fail due to the lack of sufficient room for the toes.

Range of motion exercises and manipulation of bunions and hammertoes into the correct joint positions enhances the reversal of these deformities. This procedure can be done by a therapist, yoga instructor, or physician and then done at home as part of a regular wellness program. Once again, these methods are only successful if the walker does not wear footwear that maintains the deformed joint positions.

Plainly put, most toe deformities are caused by footwear. Nearly one million surgical bunion corrections occur yearly in America, many of which could have been avoided by wearing proper shoes. If you wish to avoid bunions or hammertoes, or work towards reversing them, choose footwear that has a low heel and is wide enough in the toebox to spread your toes. Your podiatrist or therapist can help with manipulation exercises. Bunion splints are available at many pharmacies and online retailers such as www.nwfootankle.com.

Dr. Ray McClanahan is a podiatrist at the Northwest Foot and Ankle Clinic. To contact Dr. Ray McClanahan call 503-243-2699 or email footdr@nwfootankle.com.